Skip to main content
SpringerLink
Log in

Gastrointestinale Blutung

Interventionell-radiologische Diagnostik und Therapie

Gastrointestinal bleeding

Diagnostics and therapy by interventional radiology

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Moderne bildgebende Verfahren wie die (Mehrzeilen-)Spiral-CT haben neue Möglichkeiten in der Diagnostik von gastrointestinalen Blutungen geschaffen. Mit der superselektiven Transkatheterembolisation oder der TIPS-Anlage stehen auch interventionell-radiologische Therapieansätze zur Verfügung, die operative Verfahren ergänzen oder ggf. ersetzen können. Dieser Beitrag gibt eine Übersicht über die Möglichkeiten und den Stellenwert der aktuellen diagnostischen und therapeutischen interventionell-radiologischen Verfahren. Welche Verfahren jeweils zum Einsatz kommen, sollten Gastroenterologe, Chirurg und Radiologe in Abhängigkeit von lokaler Verfügbarkeit, persönlicher Erfahrung und Patientenfaktoren interdisziplinär im Einzelfall entscheiden.

Abstract

Modern imaging modalities such as (multislice) helical CT allow new diagnostic strategies for gastrointestinal hemorrhage. Today, interventional radiology with superselective transcatheter embolization or TIPS procedures allow minimally invasive therapeutic management which can support or replace surgery. This review is a synopsis of the possibilities and relative merits of diagnostic and therapeutic radiological procedures for gastrointestinal bleeding. Which of them to use should be decided collaboratively by gastroenterologist, surgeon, and radiologist depending on local availability, personal experience, and individual patient factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9

Literatur

  1. Alavi A, Dann RW, Baum S, Biery DN (1977) Scintigraphic detection of acute gastrointestinal bleeding. Radiology 124:753

    PubMed  Google Scholar 

  2. Antes G, Neher M, Hiemeyer V, Burger A (1996) Gastrointestinal bleeding of obscure origin: Role of enteroclysis. Eur Radiol 6:851

    Article  PubMed  Google Scholar 

  3. Athanasoulis CA, Baum S, Rosch J et al. (1975) Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosis. Am J Surg 129:212

    Article  PubMed  Google Scholar 

  4. Baum S, Athanasoulis CA, Waltman AD, Ring EJ (1973) Gastrointestinal hemorrhage. II. Angiographic diagnosis and control. Adv Surg 7:149

    PubMed  Google Scholar 

  5. Bandi R, Shetty PC, Sharma P, Burke TH et al. (2001) Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 12:1399

    PubMed  Google Scholar 

  6. Bonacker MJ, Begemann, PGC, Dieckmann C, Yekebas E, Adam G (2003) Stellenwert der Angiographie in der Diagnose und Therapie gastrointestinaler Blutungen. Fortschr Röntgenstr 175:524

  7. Bookstein JJ, Chlosta EM, Foley D, Walter JF (1974) Transcatheter hemostasis of gastrointestinal bleeding using modified autogenous clot. Radiology 113:277

    PubMed  Google Scholar 

  8. Chan FP, Chhor CM (2003) Active lower gastrointestinal hemorrhage diagnosed by magnetic resonance angiography: case report. Abdom Imaging 28:637

    Article  PubMed  Google Scholar 

  9. Clark RA, Colley DP, Eggers FM (1981) Acute arterial gastrointestinal hemorrhage: efficacy of transcatheter control. AJR 136:1185

    PubMed  Google Scholar 

  10. Darcy M (2003) Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization. J Vasc Interv Radiol 14:535

    PubMed  Google Scholar 

  11. Dixon PM, Roulston ME, Nolan DJ (1993) The small bowel enema: a ten year review. Clin Radiol 47:46

    PubMed  Google Scholar 

  12. Ernst O, Bulois P, Saint-Drenant S et al. (2003) Helical CT in akute lower gastrointestinal bleeding. Eur Radiol 13:114

    PubMed  Google Scholar 

  13. Ettore GC, Francisos G, Garriba AP et al. (1997) Helical CT angiography in gastrointestinal bleeding of obscure origin. Am J Roentgenol 168:727

    Google Scholar 

  14. Evangelista PT, Hallisey MJ (2000) Transcatheter embolization for acute lower gastrointestinal hemorrhage. J Vasc Interv Radiol 11:601

    PubMed  Google Scholar 

  15. Funaki B, Kostelic JK, Lorenz J et al. (2001) Superselective microcoil embolization of colonic hemorrhage. AJR 177:829

    PubMed  Google Scholar 

  16. Funaki B (2004) Microkatheter embolization of lower gastrointestinal hemorrhage: an old idea whose time has come. Cardiovasc Intervent Radiol 27:591

    Article  PubMed  Google Scholar 

  17. Gomes AS, Lois JF, McCoy RD (1986) Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization. AJR 146:1031

    PubMed  Google Scholar 

  18. Hilfiker, PR, Weishaupt D, Kacl GM et al. (1999) Comparison of three dimensional magnetic resonance imaging in conjunction with a blodd pool contrast agent and nuclear scintigraphy for the detection of experimentally induced gastrointestinal bleeding. Gut 45:581

    PubMed  Google Scholar 

  19. Jacobson AF, Cerqueira MD (1992) Prognostic significance of late imaging results in technetium99m labeled red blood cell gastrointestinal bleeding studies with early negative images. J Nucl Med 33:202

    PubMed  Google Scholar 

  20. Johnson WC, Widrich WC (1976) Efficacy of selective splanchnic arteriography and vasopressin perfusion in diagnosis and treatment of gastrointestinal hemorrhage. Am J Surg 131:481

    Article  PubMed  Google Scholar 

  21. Kuo WT, Lee DE, Saad WEA et al. (2003) Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 14:1503

    PubMed  Google Scholar 

  22. Lau WY, Ngan H, Chu KW, Yuen WK (1989) Repeat selective visceral angiography in patients with gastrointestinal bleeding of obscure origin. Br J Surg 76:226

    PubMed  Google Scholar 

  23. Layer G (2003) Radiologische Verfahren bei gastrointestinaler Blutung — Diagnostik. Dtsch Med Wochenschr 128:2074

    Article  PubMed  Google Scholar 

  24. Mandel J, Bond J, Bradley M et al. (1989) Sensitivity, specificity and positive predictive vale of the hemoccult test in screening for colorectal cancers. The University of Minnesota’s colon cancer control study. Gastroenterology 97:597

    PubMed  Google Scholar 

  25. Moch A, Herlinger H, Kochmann ML et al. (1994) Enteroclysis in the evaluation of obscure gastrointestinal bleeding. Am J Roentgenol 163:1381

    Google Scholar 

  26. Pennoyer WP, Vignati PV, Cohen JL (1996) Mangement of angiogram positive lower gastrointestinal hemorrhage: long term follow-up of non-operative treatments. Int J Colorectal Dis 11:279

    Article  PubMed  Google Scholar 

  27. Pichon N, Francois B, Pichon-Lefievre F et al. (2005) Embolization of rectal arteries: an alternative treatment for hemorrhagic shock induced by intrarectal hemorrhage. Cardiovasc Intervent Radiol 28:515

    Article  PubMed  Google Scholar 

  28. Rajan R, Dhar P, Praseedom RK, Sudhindran S, Moorthy S (2004) Role of contrast CT in acute lower gastrointestinal bleeding. Dig Surg 21:293

    Article  PubMed  Google Scholar 

  29. Ripoll C, Banares R, Beceiro I et al. (2004) Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol 15:447

    PubMed  Google Scholar 

  30. Rössle M, Haag K, Ochs A et al. (1994) The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med 330:165

    Article  PubMed  Google Scholar 

  31. Rosch J, Dotter CT, Antonovic R (1972) Selective vasoconstrictor infusion in the management of arterio-capillary gastrointestinal hemorrhage. AJR 116:279

    Google Scholar 

  32. Ryan JM, Key SM, Dumbleton SA, Smith TP (2001) Nonlocalized lower gastrointestinal bleeding: Provocative bleeding studies with intraarterial tPA, Heparin, and Tolazoline. J Vasc Interv Radiol 12:1273

    PubMed  Google Scholar 

  33. Schenker MP, Duszak R, Soulen MC et al. (2001) Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinicl and technical factors impacting success and survival. J Vasc Interv Radiol 12:1263

    PubMed  Google Scholar 

  34. Schürmann K, Bücker A, Jansen M et al. (2002) Selektive CT-Mesenterikographie zur Diagnostik schwerer Darmblutungen unklaren Ursprungs: Vorläufige Ergebnisse. Fortschr Röntgenstr 174:444

    Google Scholar 

  35. Sherman LM, Shenoy SS, Cerra FB (1979) Selective intra-arterial vasopressin: clinical efficacy and complications. Ann Surg 189:298

    PubMed  Google Scholar 

  36. Smith R, Copely DJ, Bolen FH (1987) 99MTcTBC scintigraphy: Correlation of gastrointestinal bleeding rates with scintigraphic findings. Am J Roentgenol 148:869

    Google Scholar 

  37. Tew K, Davies RP, Jadun CK, Kew J (2004) MDCT of acute lower gastrointestinal bleeding. AJR 182:427

    PubMed  Google Scholar 

  38. Waltman AC (1980) Transcatheter embolization versus vasopressin infusion for the control of arteriocapillary gastrointestinal bleeding. Cardiovasc Intervent Radiol 3:289

    PubMed  Google Scholar 

  39. Zuckerman GR, Prakash C (1998) Acute lower intestinal bleeding. Part I: Clinical presentation and diagnosis. Gastrointest Endosc 48:606

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik für Radiologische Diagnostik, Universitätsklinikum Aachen, Medizinische Fakultät der Rheinisch-Westfälischen Technischen Hochschule

    M. Wingen & R. W. Günther

  2. Klinik für Radiologische Diagnostik, Universitätsklinikum Aachen, Pauwelsstraße 30, 52057 , Aachen

    M. Wingen

Authors
  1. M. Wingen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. W. Günther
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Wingen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wingen, M., Günther, R.W. Gastrointestinale Blutung. Chirurg 77, 117–125 (2006). https://doi.org/10.1007/s00104-005-1140-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-005-1140-9

Schlüsselwörter

Keywords

Search

Navigation